Therapies for Children With Autism Spectrum Disorders

Evidence Table. Therapies for children with ASD (continued)
Study
Description Intervention
Inclusion/ Exclusion
Criteria/ Population
Comments: *Computed using Bonferroni adjusted post-hoc ANOVA
**with age in months as the covariate
Author:
Intervention:
Vismara et al.,
2009
Country:
US
Practice
setting:
Academic
Intervention
setting:
Varied including
children’s hospital,
clinical-research
university, private
intervention
agency and a
public school
Enrollment
period:
NR
Funding:
NIH, gift from
anonymous
foundation
Author industry
relationship
disclosures:
NR
Design:
Case series
Early Start Denver Model
(ESDM); incorporates the
Denver model (a relationship
and play-based
developmental intervention)
and Pivotal
Response Training (ABA
application to optimize
motivation to increase
communication, language,
and play skills)
Phase I: direct intervention
of the ESDM
included manualized
instruction in the teaching
principles, intervention
techniques, goal
development and data
collection methods, and
fidelity system (5 months)
Phase II: parent coaching
of the ESDM included
teaching therapists to
educate parents on how
to carry out the ESDM
principles (5 months)
Both training phases
consisted of an initial
baseline session followed
by three training
conditions, each lasting
approximately
5-6 weeks: (i) selfinstruction
with the
training materials using
print and video materials
provided on a DVD;
(ii) a 10 hour didactic
training seminar for direct
treatment and a 3 hour
didactic training seminar
for parent coaching; and
(iii) four hours of team
supervision for specific
discussion of each site’s
Inclusion criteria:
• Age 12-60 months
• Diagnosis of ASD
• No significant health
concerns
• No serious or specific
medical, genetic, neurological,
or sensory
condition
• Parental consent for
videotaping
• At least 75% parental
attendance if the family
continued onto the
parent training phase
• No participation in
additional services
exceeding 10 hours per
week during the study
Exclusion criteria:
• See inclusion criteria
Age, months ± SD:
G1a: 33 ± 7.3
G1b: 33 ± 7.7
G2a: 33 ± 4.4
G2b: 31 ± 6
Mental age:
NR
Gender:
NR
Race/ethnicity:
NR
SES:
Maternal education: NR
Household income: NR
Diagnostic approach:
Referral
Diagnostic tool/method:
Initially diagnosed by
community clinicians
independent of this study,
confirmed by trained
physician or psychologist
Diagnostic Tool:
DSM-IV, ADOS
C-102
Baseline
Measures Outcomes
Overall:
ANCOVA:** treatment
(P < 0.0002;
partial ɳ 2 = 0.346)
Harms:
NR
Modifiers:
NR
Overall ratings: Social skills:
MSEL develop- Number of words,
mental age, months phase I, mean
± SD:
(SE):
Receptive language: G1i: 10.3 (4.63)
G1a: 22 ± 13 G1ii: 21.4 (4.63)
G1b: 14 ± 9.2 G1iii: 13.5 (4.63)
G2a: 15 ± 12.3 G1i/BL: P = NS
G2b: 15 ± 12.8 G1i/G1ii: P < 0.01
Expressive G1ii/G1iii: P <
language:
0.05
G1a: 23 ± 10 Number of words,
G1b: 16 ± 6.9 phase II, mean ±
G2a: 13 ± 11 SD:
G2b: 14 ± 12.5 G2i: 15.5 ± 10.99
ADOS score, G2ii: 20.89 ± 16.1
module 1, mean ± G2iii: 28.22 ±
SD:
23.42
G1a: 13 ± 4.4 G2i/G2ii/G2iii/BL:
G1b: 15 ± 4.9 P = NS
G2a: 17 ± 3.9 Number of imita-
G2b: 15 ± 5.3 tions, mean ± SD:
Social skills: G1i: NR
Number of words, G1ii: NR
phase I, mean (SE): G1iii: NR
G1: 9.5 (4.63) G2i: 11 ± 8.38
Number of words, G2ii: 13.56 ± 9.81
phase II, mean ± G2iii: 8.11 ± 9.83
SD:
G1i/G1ii/G1iii/BL:
G2: 22.29 ± 27.13 P = NS
Number of imita- G2i/G2ii/G2iii/BL:
tions, mean ± SD: P = NS
G1: NR
Attention score,
G2: 14.57 ± 10.67 mean ± SD:
Attention score, G1i: NR**
mean ± SD: G1ii: NR**
G1: NR
G1iii: NR**
G2: 3.00 ± 0.75 G2i: 3.26 ± 0.66
Social initiations, G2ii: 3.46 ± 0.63
mean ± SD: G2iii: 3.54 ± 0.79
G1: NR
G1i/BL: P < 0.05
G2: 2.84 ± 0.45 G1i/G1ii+G1iii: P
Therapist treatment < 0.05
fidelity, score, mean G1ii/G1iii: P = NS
(SE):
G2i/G2ii/G2iii/BL:
G1a: NR** P = NS